Teaching children pedestrian safety in virtual reality via smartphone: a noninferiority randomized clinical trial.

OBJECTIVE: To evaluate whether child pedestrian safety training in a smartphone-based virtual reality (VR) environment is not inferior to training in a large, semi-immersive VR environment with demonstrated effectiveness. METHODS: Five hundred 7- and 8-year-old children participated; 479 were randomized to one of two conditions: Learning to cross streets in a smartphone-based VR or learning in a semi-immersive kiosk VR. The systems used identical virtual environments and scenarios. At baseline, children's pedestrian skills were assessed in both VR systems and through a vehicle approach estimation task (judging speed/distance of oncoming traffic on monitor). Training in both conditions comprised at least six 30-min sessions in the randomly assigned VR platform and continued for up to 25 visits until adult-level proficiency was obtained. Following training and again 6 months later, children completed pedestrian safety assessments identical to baseline. Three outcomes were considered from assessments in each VR platform: Unsafe crossings (collisions plus close calls), time to contact (shortest time between child and oncoming simulated traffic), and missed opportunities (unselected safe opportunities to cross). RESULTS: Participants achieved adult-level street-crossing skill through VR training. Training in a smartphone-based VR system was generally not inferior to training in a large semi-immersive VR system. There were no adverse effects. CONCLUSIONS: Seven- and 8-year-old children can learn pedestrian safety through VR-based training, including training in a smartphone-based VR system. Combined with recent meta-analytic results, the present findings support broad implementation and dissemination of child pedestrian safety training through VR, including smartphone-based VR systems.

Pilot imaging of the colony stimulating factor 1 receptor in the brains of virally-suppressed individuals with HIV.

OBJECTIVE: Neuroimmune activation is a putative driver of cognitive impairment in people with HIV (PWH), even in the age of modern antiretroviral therapy. Nevertheless, imaging of the microglial marker, the 18 kDa translocator protein (TSPO), with positron emission tomography (PET) in treated PWH has yielded inconclusive findings. One potential reason for the varied TSPO results is a lack of cell-type specificity of the TSPO target. DESIGN: [ 11 C]CPPC, 5-cyano- N -(4-(4-[ 11 C]methylpiperazin-1-yl)-2-(piperidin-1-yl)phenyl) furan-2-carboxaminde, is a radiotracer for use with PET to image the colony stimulating factor 1 receptor (CSF1R). The CSF1R is expressed on microglia and central nervous system macrophages, with little expression on other cell types. We used [ 11 C]CPPC PET in virally-suppressed- (VS)-PWH and HIV-uninfected individuals to estimate the effect sizes of higher CSF1R in the brains of VS-PWH. METHODS: Sixteen VS-PWH and 15 HIV-uninfected individuals completed [ 11 C]CPPC PET. [ 11 C]CPPC binding (V T ) in nine regions was estimated using a one-tissue compartmental model with a metabolite-corrected arterial input function, and compared between groups. RESULTS: Regional [ 11 C]CPPC V T did not significantly differ between groups after age- and sex- adjustment [unstandardized beta coefficient ( B ) = 1.84, standard error (SE) = 1.18, P  = 0.13]. The effect size was moderate [Cohen's d  = 0.56, 95% confidence interval (CI) -0.16, 1.28), with strongest trend of higher V T in VS-PWH in striatum and parietal cortex (each P  = 0.04; Cohen's d  = 0.71 and 0.72, respectively). CONCLUSIONS: A group difference in [ 11 C]CPPC V T was not observed between VS-PWH and HIV-uninfected individuals in this pilot, although the observed effect sizes suggest the study was underpowered to detect regional group differences in binding.

Using a smartwatch and smartphone to assess early Parkinson's disease in the WATCH-PD study.

Digital health technologies can provide continuous monitoring and objective, real-world measures of Parkinson's disease (PD), but have primarily been evaluated in small, single-site studies. In this 12-month, multicenter observational study, we evaluated whether a smartwatch and smartphone application could measure features of early PD. 82 individuals with early, untreated PD and 50 age-matched controls wore research-grade sensors, a smartwatch, and a smartphone while performing standardized assessments in the clinic. At home, participants wore the smartwatch for seven days after each clinic visit and completed motor, speech and cognitive tasks on the smartphone every other week. Features derived from the devices, particularly arm swing, the proportion of time with tremor, and finger tapping, differed significantly between individuals with early PD and age-matched controls and had variable correlation with traditional assessments. Longitudinal assessments will inform the value of these digital measures for use in future clinical trials.

Physical activity and cognitive function: A comparison of rural and urban breast cancer survivors.

PURPOSE: Increasing evidence suggests rural breast cancer survivors (BCS) may experience greater burden in symptoms known to be associated with cancer-associated cognitive decline (CACD). Yet, little is known about CACD in rural BCS. This study (1) examined differences in cognitive function, moderate-to-vigorous physical activity (MVPA), and other CACD correlates and (2) tested the effects of MVPA on cognitive function in rural versus urban BCS. METHODS: Rural and urban BCS (N = 80), matched on age, education, and time since diagnosis from a larger study, completed cognitive tasks assessing processing speed (Trails-B, Mazes, Task-Switch) and working memory (spatial working memory) and questionnaires assessing subjective memory impairment (SMI), MVPA, and CACD correlates (i.e., sleep quality, fatigue, anxiety/depression). Some participants (n = 62) wore an accelerometer to objectively estimate MVPA. Multiple linear regression and multivariate analysis of covariance were used to test study aims. RESULTS: Rural BCS (n = 40, M = 61.1±8.4 years-old) performed significantly slower on Trails-B (p<0.01) compared with urban BCS (n = 40, M = 61.0±8.2 years-old) and engaged in less objectively-estimated daily MVPA (mean difference = 13.83±4.73 minutes; p = 0.01). No significant differences in SMI, self-reported MVPA, or CACD correlates were observed (all p>0.28). Regression models did not reveal a significant interaction between MVPA and cognitive performance (all p>0.1); however, estimated marginal means models indicated that the effect of MVPA on processing speed was evident only among rural BCS (Trails-B, p = 0.04; Mazes, p = 0.03). CONCLUSIONS: Findings suggest rural BCS may suffer greater CACD and engage in less MVPA. Additional research is warranted to further examine CACD and more effectively promote MVPA in rural BCS.

Driving Performance and Cannabis Users' Perception of Safety: A Randomized Clinical Trial.

IMPORTANCE: Expanding cannabis medicalization and legalization increases the urgency to understand the factors associated with acute driving impairment. OBJECTIVE: To determine, in a large sample of regular cannabis users, the magnitude and time course of driving impairment produced by smoked cannabis of different Δ9-tetrahydrocannabinol (THC) content, the effects of use history, and concordance between perceived impairment and observed performance. DESIGN, SETTING, AND PARTICIPANTS: This double-blind, placebo-controlled parallel randomized clinical trial took place from February 2017 to June 2019 at the Center for Medicinal Cannabis Research, University of California San Diego. Cannabis users were recruited for this study, and analysis took place between April 2020 and September 2021. INTERVENTIONS: Placebo or 5.9% or 13.4% THC cannabis smoked ad libitum. MAIN OUTCOMES AND MEASURES: The primary end point was the Composite Drive Score (CDS), which comprised key driving simulator variables, assessed prior to smoking and at multiple time points postsmoking. Additional measures included self-perceptions of driving impairment and cannabis use history. RESULTS: Of 191 cannabis users, 118 (61.8%) were male, the mean (SD) age was 29.9 (8.3) years, and the mean (SD) days of use in the past month was 16.7 (9.8). Participants were randomized to the placebo group (63 [33.0%]), 5.9% THC (66 [34.6%]), and 13.4% THC (62 [32.5%]). Compared with placebo, the THC group significantly declined on the Composite Drive Score at 30 minutes (Cohen d = 0.59 [95% CI, 0.28-0.90]; P < .001) and 1 hour 30 minutes (Cohen d = 0.55 [95% CI, 0.24-0.86]; P < .001), with borderline differences at 3 hours 30 minutes (Cohen d = 0.29 [95% CI, -0.02 to 0.60]; P = .07) and no differences at 4 hours 30 minutes (Cohen d = -0.03 [95% CI, -0.33 to 0.28]; P = .87). The Composite Drive Score did not differ based on THC content (likelihood ratio χ24 = 3.83; P = .43) or use intensity (quantity × frequency) in the past 6 months (likelihood ratio χ24 = 1.41; P = .49), despite postsmoking blood THC concentrations being higher in those with the highest use intensity. Although there was hesitancy to drive immediately postsmoking, increasing numbers (81 [68.6%]) of participants reported readiness to drive at 1 hour 30 minutes despite performance not improving from initial postsmoking levels. CONCLUSIONS AND RELEVANCE: Smoking cannabis ad libitum by regular users resulted in simulated driving decrements. However, when experienced users control their own intake, driving impairment cannot be inferred based on THC content of the cigarette, behavioral tolerance, or THC blood concentrations. Participants' increasing willingness to drive at 1 hour 30 minutes may indicate a false sense of driving safety. Worse driving performance is evident for several hours postsmoking in many users but appears to resolve by 4 hours 30 minutes in most individuals. Further research is needed on the impact of individual biologic differences, cannabis use history, and administration methods on driving performance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02849587.

Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study.

BACKGROUND: Neurological complications including cognitive impairment persist among people with HIV on antiretrovirals; however, cognitive screening is not routinely conducted in HIV clinics. OBJECTIVE: Our objective for this study was 3-fold: (1) to determine the feasibility of implementing an iPad-based cognitive impairment screener among adults seeking HIV care, (2) to examine the psychometric properties of the tool, and (3) to examine predictors of cognitive impairment using the tool. METHODS: A convenience sample of participants completed Brain Baseline Assessment of Cognition and Everyday Functioning (BRACE), which included (1) Trail Making Test Part A, measuring psychomotor speed; (2) Trail Making Test Part B, measuring set-shifting; (3) Stroop Color, measuring processing speed; and (4) the Visual-Spatial Learning Test. Global neuropsychological function was estimated as mean T score performance on the 4 outcomes. Impairment on each test or for the global mean was defined as a T score ≤40. Subgroups of participants repeated the tests 4 weeks or >6 months after completing the first test to evaluate intraperson test-retest reliability and practice effects (improvements in performance due to repeated test exposure). An additional subgroup completed a lengthier cognitive battery concurrently to assess validity. Relevant factors were abstracted from electronic medical records to examine predictors of global neuropsychological function. RESULTS: The study population consisted of 404 people with HIV (age: mean 53.6 years; race: 332/404, 82% Black; 34/404, 8% White, 10/404, 2% American Indian/Alaskan Native; 28/404, 7% other and 230/404, 58% male; 174/404, 42% female) of whom 99% (402/404) were on antiretroviral therapy. Participants completed BRACE in a mean of 12 minutes (SD 3.2), and impairment was demonstrated by 34% (136/404) on Trail Making Test A, 44% (177/404) on Trail Making Test B, 40% (161/404) on Stroop Color, and 17% (67/404) on Visual-Spatial Learning Test. Global impairment was demonstrated by 103 out of 404 (25%). Test-retest reliability for the subset of participants (n=26) repeating the measure at 4 weeks was 0.81 and for the subset of participants (n=67) repeating the measure almost 1 year later (days: median 294, IQR 50) was 0.63. There were no significant practice effects at either time point (P=.20 and P=.68, respectively). With respect for validity, the correlation between global impairment on the lengthier cognitive battery and BRACE was 0.63 (n=61; P<.001), with 84% sensitivity and 94% specificity to impairment on the lengthier cognitive battery. CONCLUSIONS: We were able to successfully implement BRACE and estimate cognitive impairment burden in the context of routine clinic care. BRACE was also shown to have good psychometric properties. This easy-to-use tool in clinical settings may facilitate the care needs of people with HIV as cognitive impairment continues to remain a concern in people with HIV.

Study protocol: developing and evaluating an interactive web platform to teach children hunting, shooting and firearms safety: a randomized controlled trial.

BACKGROUND: Firearms injuries present a major pediatric public health challenge in the United States. This study protocol describes research to develop and then conduct a randomized clinical trial to evaluate ShootSafe, an interactive, engaging, educational website to teach children firearms safety. ShootSafe has three primary goals: (a) teach children basic knowledge and skills needed to hunt, shoot, and use firearms safely; (b) help children learn and hone critical cognitive skills of impulse control and hypothetical thinking needed to use firearms safely; and (c) alter children's perceptions about their own vulnerability and susceptibility to firearms-related injuries, the severity of those injuries, and their perceived norms about peer behavior surrounding firearms use. ShootSafe will accomplish these goals through a combination of interactive games plus short, impactful testimonial videos and short expert-led educational videos. METHODS: Following website development, ShootSafe will be evaluated through a randomized controlled trial with 162 children ages 10-12, randomly assigning children to engage in ShootSafe or an active control website. Multiple self-report, computer-based, and behavioral measures will assess functioning at baseline, immediately following training, and at 4-month follow-up. Four sets of outcomes will be considered: firearms safety knowledge; cognitive skills in impulse control and hypothetical thinking; perceptions about firearms safety; and simulated behavior when handling, storing and transporting firearms. Training in both conditions will comprise two 45-min sessions. DISCUSSION: If results are as hypothesized, ShootSafe offers potential as a theory-based program to teach children firearms safety in an accessible, engaging and educational manner. Translation into practice is highly feasible. TRIAL REGISTRATION: The study protocol was registered on 11/10/20 at clinicaltrials.gov ( NCT04622943 ).

Influence of sitting behaviors on sleep disturbance and memory impairment in breast cancer survivors.

BACKGROUND: The purpose was to prospectively examine the effects of sedentary behaviors on subjective memory impairment in breast cancer survivors (BCS) and the extent to which sleep disturbances mediated this pathway. METHODS: BCS (N = 380; Mage  = 57.38 ± 9.25 years) completed questionnaires assessing demographics, health history, sitting behaviors, sleep disturbance, subjective memory impairment, and moderate-to-vigorous physical activity (MVPA) at baseline and 6-month follow-up. A subsample (N = 300) wore an accelerometer to objectively estimate sedentary time and MVPA. Structural equation modeling was used to test direct and indirect effects of self-reported and objectively estimated sedentary behaviors on memory impairment (through sleep disturbance) across time. Models were adjusted for demographic, clinical, and MVPA covariates. RESULTS: At baseline, more total daily sitting (γ = 0.23), occupational sitting (γ = 0.11), television viewing (γ = 0.15), and computer use (γ = 0.22) were associated with greater sleep disturbance, which was associated with greater memory impairment (γ = -0.22). Indirect effects of self-reported sitting on memory were significant. At follow-up, increased total daily sitting (γ = 0.08) and computer use (γ = 0.14) predicted increased sleep disturbance, which predicted increased memory impairment (γ = -0.09). The indirect path from increased computer use to memory impairment was significant (ß = -0.01). In the accelerometer subsample, greater daily sedentary time at baseline was associated with less sleep disturbance (γ = -0.14) and memory impairment (indirect effect: ß = 0.03). CONCLUSIONS: Findings provide early evidence that sedentary contexts may differentially influence sleep disturbance and memory impairment in BCS. Computer use and television viewing may pose the strongest risks to cognitive health. Disparate findings between objective and subjective sedentary measures warrant further research.

Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors.

BACKGROUND: Evidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors. METHODS: Breast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep. RESULTS: MVPA was associated with faster Task-switch reaction time in the partition models (stay: B = - 35.31, p = 0.02; switch: B = - 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = - 29.37, p = 0.04) and switch (B = - 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = - 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = - 3.55, p = 0.03; Trails B: B = - 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = - 4.35, p = 0.02) and Trails B (B = - 5.23, p = 0.03) completion. CONCLUSIONS: Findings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted. TRIAL REGISTRATION: This study is registered with United States ClinicalTrials.gov ( NCT02523677 ; 8/14/2015).

Effects of physical activity on psychological well-being outcomes in breast cancer survivors from prediagnosis to posttreatment survivorship.

OBJECTIVE: The purpose of this study was to examine the effects of physical activity from prediagnosis to posttreatment survivorship on the psychological well-being (PWB) outcomes of fatigue, depression, anxiety, and quality of life (QoL) in breast cancer survivors (BCS). METHODS: Participants (N = 387) completed a questionnaire battery by using an iPad-based platform. Measures included self-reported PA (before diagnosis and currently) and perceptions of fatigue, depression, anxiety, and QoL. Multivariate analysis of covariance was used to examine differences in PWB among BCS categorized into 1 of 4 physical activity levels: (a) low-active prediagnosis, low-active currently (low-active maintainers; n = 128); (b) low-active prediagnosis, active currently (increasers; n = 74); (c) active prediagnosis, low-active currently (decreasers; n = 52); and (d) active prediagnosis, active currently (high-active maintainers; n = 136). Participants were classified as active (≥24 units) or low-active (<24 units) by using Godin Leisure-Time Exercise Questionnaire cut-points for health benefits. RESULTS: Fatigue and depression were lowest, and QoL was highest among women in the high-active maintainers category, followed by the increasers, low-active maintainers, and decreasers. No differences in anxiety were observed across categories. Women in the high-active maintainers category differed significantly in fatigue, depression, and QoL from both low-active categories (low-active maintainers and decreasers), P ≤ .001. Women in the increasers category also differed significantly in fatigue, depression, and QoL from the decreasers, P ≤ .01. CONCLUSION: Low physical activity during survivorship was associated with greater fatigue and depression and lower QoL. IMPLICATIONS FOR CANCER SURVIVORS: Efforts to help increase or maintain high levels of physical activity may be critical to helping BCS maintain their PWB.

Featured Article: Evaluating Smartphone-Based Virtual Reality to Improve Chinese Schoolchildren's Pedestrian Safety: A Nonrandomized Trial.

Objective: This nonrandomized trial evaluated whether classroom-based training in a smartphone-based virtual reality (VR) pedestrian environment (a) teaches schoolchildren to cross streets safely, and (b) increases their self-efficacy for street-crossing. Methods: Fifty-six children, aged 8-10 years, attending primary school in Changsha, China participated. Baseline pedestrian safety assessment occurred in the VR environment and through unobtrusive observation of a subsample crossing a street for 11 days outside school. Self-efficacy was assessed through both self-report and observation. Following baseline, children engaged in the VR for 12 days in their classrooms, honing complex cognitive-perceptual skills required to engage safely in traffic. Follow-up assessment replicated baseline. Results: Probability of crash in the VR decreased posttraining (0.40 vs. 0.09), and observational data found the odds of looking at oncoming traffic while crossing the first lane of traffic increased (odds ratio [OR] = 2.4). Self-efficacy increases occurred in self-report (proportional OR = 4.7 crossing busy streets) and observation of following crossing-guard signals (OR = 0.2, first lane). Conclusions: Pedestrian safety training via smartphone-based VR provides children the repeated practice needed to learn the complex skills required to cross streets safely, and also helps them improve self-efficacy to cross streets. Given rapid motorization and global smartphone penetration, plus epidemiological findings that about 75,000 children die annually worldwide in pedestrian crashes, smartphone-based VR could supplement existing policy and prevention efforts to improve global child pedestrian safety.

The effects of physical activity and fatigue on cognitive performance in breast cancer survivors.

PURPOSE: Research suggests that physical activity may be a promising treatment for cancer-related cognitive impairment; however, evidence is limited by small samples and self-report measures and little is known about the underlying mechanisms. The purpose of this study was to examine the effects of physical activity on cognitive function in a national sample of breast cancer survivors (BCSs) using objective measures. We hypothesized that physical activity's effects on cognition would be indirect through survivors' self-reported fatigue. METHODS: Participants (N = 299; M = 57.51 ± 9.54 years) included BCSs with access to an iPad. Participants wore an accelerometer for seven consecutive days to measure their average daily minutes of moderate-to-vigorous physical activity (MVPA) and completed a battery of questionnaires and neuropsychological tests via an iPad application to measure fatigue and cognitive function. Cognitive function was modeled as two latent factors-executive function and working memory-comprising performance across seven cognitive tasks. A structural equation modeling framework was used to test the hypotheses. RESULTS: MVPA was associated with less fatigue (γ = 0.19), which, in turn, was associated with faster times on executive function tasks (γ = -0.18) and greater accuracy on working memory tasks (γ = 0.16). The indirect paths from MVPA to cognitive performance were also significant (executive function: ß = -0.03, memory: ß = 0.03). CONCLUSIONS: Findings suggest that MVPA may be associated with greater executive function and working memory in BCSs. Further, this effect may be partially indirect through cancer-related symptoms (e.g., fatigue). Results emphasize the need for additional scientific investigation in the context of prospective and efficacy trials.

Aging affects spatial reconstruction more than spatial pattern separation performance even after extended practice.

Although the hippocampus experiences age-related anatomical and functional deterioration, the effects of aging vary across hippocampal-dependent cognitive processes. In particular, whether or not the hippocampus is known to be required for a spatial memory process is not an accurate predictor on its own of whether aging will affect performance. Therefore, the primary objective of this study was to compare the effects of healthy aging on a test of spatial pattern separation and a test of spatial relational processing, which are two aspects of spatial memory that uniquely emphasize the use of multiple hippocampal-dependent processes. Spatial pattern separation supports spatial memory by preserving unique representations for distinct locations. Spatial relational processing forms relational representations of objects to locations or between objects and other objects in space. To test our primary objective, 30 young (18-30 years; 21F) and 30 older participants (60-80 years; 21F) all completed a spatial pattern separation task and a task designed to require spatial relational processing through spatial reconstruction. To ensure aging effects were not due to inadequate time to develop optimal strategies or become comfortable with the testing devices, a subset of participants had extended practice across three sessions on each task. Results showed that older adults performed more poorly than young on the spatial reconstruction task that emphasized the use of spatial relational processing, and that age effects persisted even after controlling for pattern separation performance. Further, older adults performed more poorly on spatial reconstruction than young adults even after three testing sessions each separated by 7-10 days, suggesting effects of aging are resistant to extended practice and likely reflect genuine decline in hippocampal memory abilities.

Virtual reality by mobile smartphone: improving child pedestrian safety.

BACKGROUND: Pedestrian injuries are a leading cause of paediatric injury. Effective, practical and cost-efficient behavioural interventions to teach young children street crossing skills are needed. They must be empirically supported and theoretically based. Virtual reality (VR) offers promise to fill this need and teach child pedestrian safety skills for several reasons, including: (A) repeated unsupervised practice without risk of injury, (B) automated feedback on crossing success or failure, (C) tailoring to child skill levels: (D) appealing and fun training environment, and (E) most recently given technological advances, potential for broad dissemination using mobile smartphone technology. OBJECTIVES AND METHODS: Extending previous work, we will evaluate delivery of an immersive pedestrian VR using mobile smartphones and the Google Cardboard platform, technology enabling standard smartphones to function as immersive VR delivery systems. We will overcome limitations of previous research suggesting children learnt some pedestrian skills after six VR training sessions but did not master adult-level pedestrian skills by implementing a randomised non-inferiority trial with two equal-sized groups of children ages 7-8 years (total N=498). All children will complete baseline, postintervention and 6-month follow-up assessments of pedestrian safety and up to 25 30-min pedestrian safety training trials until they reach adult levels of functioning. Half the children will be randomly assigned to train in Google Cardboard and the other half in a semi-immersive kiosk VR. Analysis of Covariance (ANCOVA) models will assess primary outcomes. DISCUSSION: If results are as hypothesised, mobile smartphones offer substantial potential to overcome barriers of dissemination and implementation and deliver pedestrian safety training to children worldwide.

Using smartphone technology to deliver a virtual pedestrian environment: usability and validation.

Various programs effectively teach children to cross streets more safely, but all are labor- and cost-intensive. Recent developments in mobile phone technology offer opportunity to deliver virtual reality pedestrian environments to mobile smartphone platforms. Such an environment may offer a cost- and labor-effective strategy to teach children to cross streets safely. This study evaluated usability, feasibility, and validity of a smartphone-based virtual pedestrian environment. A total of 68 adults completed 12 virtual crossings within each of two virtual pedestrian environments, one delivered by smartphone and the other a semi-immersive kiosk virtual environment. Participants completed self-report measures of perceived realism and simulator sickness experienced in each virtual environment, plus self-reported demographic and personality characteristics. All participants followed system instructions and used the smartphone-based virtual environment without difficulty. No significant simulator sickness was reported or observed. Users rated the smartphone virtual environment as highly realistic. Convergent validity was detected, with many aspects of pedestrian behavior in the smartphone-based virtual environment matching behavior in the kiosk virtual environment. Anticipated correlations between personality and kiosk virtual reality pedestrian behavior emerged for the smartphone-based system. A smartphone-based virtual environment can be usable and valid. Future research should develop and evaluate such a training system.

Evaluating a Website to Teach Children Safety with Dogs: A Randomized Controlled Trial.

Dog bites represent a significant threat to child health. Theory-driven interventions scalable for broad dissemination are sparse. A website was developed to teach children dog safety via increased knowledge, improved cognitive skills in relevant domains, and increased perception of vulnerability to bites. A randomized controlled trial was conducted with 69 children aged 4-5 randomly assigned to use the dog safety website or a control transportation safety website for ~3 weeks. Assessment of dog safety knowledge and behavior plus skill in three relevant cognitive constructs (impulse control, noticing details, and perspective-taking) was conducted both at baseline and following website use. The dog safety website incorporated interactive games, instructional videos including testimonials, a motivational rewards system, and messaging to parents concerning child lessons. Our results showed that about two-thirds of the intervention sample was not adherent to website use at home, so both intent-to-treat and per-protocol analyses were conducted. Intent-to-treat analyses yielded mostly null results. Per-protocol analyses suggested children compliant to the intervention protocol scored higher on knowledge and recognition of safe behavior with dogs following the intervention compared to the control group. Adherent children also had improved scores post-intervention on the cognitive skill of noticing details compared to the control group. We concluded that young children's immature cognition can lead to dog bites. Interactive eHealth training on websites shows potential to teach children relevant cognitive and safety skills to reduce risk. Compliance to website use is a challenge, and some relevant cognitive skills (e.g., noticing details) may be more amenable to computer-based training than others (e.g., impulse control).

Community-based pedestrian safety training in virtual reality: A pragmatic trial.

Child pedestrian injuries are a leading cause of mortality and morbidity across the United States and the world. Repeated practice at the cognitive-perceptual task of crossing a street may lead to safer pedestrian behavior. Virtual reality offers a unique opportunity for repeated practice without the risk of actual injury. This study conducted a pre-post within-subjects trial of training children in pedestrian safety using a semi-mobile, semi-immersive virtual pedestrian environment placed at schools and community centers. Pedestrian safety skills among a group of 44 seven- and eight-year-old children were assessed in a laboratory, and then children completed six 15-minute training sessions in the virtual pedestrian environment at their school or community center following pragmatic trial strategies over the course of three weeks. Following training, pedestrian safety skills were re-assessed. Results indicate improvement in delay entering traffic following training. Safe crossings did not demonstrate change. Attention to traffic and time to contact with oncoming vehicles both decreased somewhat, perhaps an indication that training was incomplete and children were in the process of actively learning to be safer pedestrians. The findings suggest virtual reality environments placed in community centers hold promise for teaching children to be safer pedestrians, but future research is needed to determine the optimal training dosage.

Evaluating a website to teach children safety with dogs.

BACKGROUND: Paediatric dog bites are a significant public health problem worldwide. Existing prevention programmes focused on altering children's risky behaviour with pet dogs tend to be atheoretical and only moderately effective. OBJECTIVE: Test efficacy of a website to train young children in relevant cognitive skills to be safe with pet dogs in their home. SETTING: Birmingham, Alabama, USA. METHODS: A randomised trial will be conducted with an expected sample of two groups of 34 children (total N=68) ages 4-6 years. One group will engage in the newly designed website at home for 2 weeks and the other group will engage in a control website on transportation safety for an equivalent amount of time. All participants will complete a battery of laboratory-based tests to assess safety with dogs and cognitive functioning at baseline and postintervention. OUTCOME MEASURES: Primary analyses will be conducted through linear mixed models testing change over time. Children's cognitive functioning, knowledge about safety with dogs, and behaviour with dogs in simulation and in vivo will serve as the primary outcomes. CLINICAL TRIAL REGISTRATION: This study is exempt from registry at the US government website, http://www.clinicaltrials.gov, based on being a behavioural trial in the early phases of testing.